Telepractice : Providing Speech Therapy Online

1. Telepractice: Providing Speech Therapy Online Presented by: Jacquelyn Taylor, M.S., CCC-SLP

2. What is Telepractice? • Telepractice is a way to provide speech/language therapy services (service delivery model, not a technique) • Although it is relatively new to the speech, occupational and physical therapy fields (within the last 5 years), telepractice has been used for some time to provide medical services and mental health counseling • Services are provided through the use of web cameras and video conferencing systems in real time.

3. ASHA Position Statement American Speech-Language Hearing Association (ASHA*) Telepractice is the application of telecommunications technology to deliver professional services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation. It is the position of the American Speech-Language-Hearing Association (ASHA) that telepractice (telehealth) is an appropriate model of service delivery for the profession of speech-language pathology. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility. Telepractice offers the potential to extend clinical services to remote, rural, and underserved populations, and to culturally and linguistically diverse populations. The use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g., licensure, HIPAA, etc.), and ASHA policy documents on professional practices. Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face. Reference: http://www.asha.org/docs/html/PS2005-00116.html

4. MYTH: Speech Therapy must be done in person

5. FACT: Students who receive therapy online perform just as well and in some cases better, than students with an in-person therapist.

6. Research – Kent State University (KSU) Year 1 • NSD in two conditions as measured by standardized tests, progress reports, • NOMS comparison • Satisfaction Survey Results (Grogan-Johnson, Alvares, Rowan & Creaghead, 2010) Year 2 • Students in both conditions made progress as measured by change in GFTA-2 • scores. However, students in telepractice made significantly more improvement. • Chi-Square test suggests that students in telepractice were more likely to • Master IEP goals then children in side-by-side condition. (Grogan-Johnson, Gabel, Taylor, Rowan, Alvares & Schenker, 2011) Year 3 • Comparison with School Age NOMS • Caution in interpretation • Similarities in caseloads/Amount of time in tx/Amount of change Summer Project • NSD with listener ratings and test results for speech intervention provided via telepractice and traditional intervention

7. About Me • ASHA-certified Speech Language Pathologist (SLP) • Actively licensed in GA, NC and SC • Previously licensed in OH, VA, MD, AK • SLP for 18 years, primarily servicing schools • 4 years as an early intervention provider • 5years providing services via telepractice • 2 years: primary researcher at Kent State University • 3 years: TheraWeb Manager at Therapy Source, Inc.

8. Why Telepractice? • Gives schools assurance due to: • Compliance with No Child Left Behind (NCLB) and Individuals with Disabilities Education Act (IDEA) • IEPrequirements being met in individual or group sessions • Availability of services in all educational environments: online, blended and brick-and-mortar • Access to highly trained, Master’s level SLPs from across the country

9. Benefits for Schools • Bridgesservice gaps • Maintains compliance • Immediate coverage until in-person sessions are possible • Solves therapist availability issues • Addresses shortage of qualified therapists in state • Helps ensure schools’ compliance • Flexible scheduling • Alleviates the pain of scheduling issues • Increases parental awareness over child’s treatment • Enables services before or after classes…including ESY

10. Benefits for Schools (continued) • Significant cost savings: possible with telepractice! • Budget relief – costs go; successful outcomes can stay! • Trims expense of in-house therapist • Schools can allocate savings to other important resources. • Mitigates risk of complaints/mediation/due process hearings: peace of mind.

11. Benefits for Students • Serves students in remote or under-served areas • Supports those with limited mobility • Ensures a comfortable, easy-to-access treatment • environment for those with severedisabilities and their • families • Motivates students to fully engage in therapy sessions, • resulting in progress and achieving goals

12. Challenges • School-specific challenges: • Buy-in from teachers, administrators and parents • Technology: equipment/infrastructure and support • Startup and operating costs (e.g. “speech lab”) • Ensuring functional outcomes and carryover • General challenges: • Working effectively and ethically with a paraprofessional • Collaboration among therapist, school and parents • Documentation (e.g. IEP writing)

13. Big Picture: Telepractice is Essential

14. Parent Satisfaction – KSU Greenfield Elementary School, 2010

15. Staff Satisfaction Results - KSU Greenfield Elementary School, 2010

16. Parent Satisfaction – TheraWeb Therapy Source, Inc., 2012

17. Parent Satisfaction – TheraWeb Therapy Source, Inc., 2013

18. Parent Satisfaction – Comments Therapy Source, Inc., 2013 • She has been able to accomplish more with my son online than others have in the past (combined) within brick and mortar atmospheres. • This is the best speech therapy we have ever had • It has been wonderfully effective, I've seen leaps of progress in my child • Want this again for my child in the next school year • We both appreciate not having to drive to a facility for therapy. What a surprise to learn that she could have speech therapy provided in this way • I was unsure about whether this would be an effective way to do speech therapy, but it has been WONDERFUL! Mrs. ……has been so helpful, and you can't beat the convenience of not having to leave our home. We give it big thumbs up and have recommended it to several people who have expressed reservations. • My son greatly enjoys his therapy sessions....he gets to work on the computer {which is something he never got to do with other speech therapists}. This made him enjoy his speech therapies more than he ever has before. • In the beginning I was really unsure about how effective the online sessions would be. Now I'm a firm believer. Jesse is so interested in the computer he stays more focused online than he would in person. • This was our first year doing speech online. He loved it. I loved the fact that we didn't have to drive to another location.

19. Type of Telepractice Services* *Speech, occupational, behavioral and physical therapy is available via telepractice; the number and percentage of students currently receiving services under my management is depicted below.

20. Not all states discuss telepracticein speech-language pathology licensure laws 12+ states and the District of Columbia have specific telepractice provisions for speech therapy South Carolina does not have telepractice provisions for speech therapy The therapist MUSTbe licensed in home and students’ state South Carolina has issued guidance for telehealth for occupational therapy* *http://www.llr.state.sc.us/pol/occupationaltherapy/index.asp?file=TelehealthFAQ.HTM State Laws

21. Equipment Checklist DEPENDS ON LEVEL OF VIDEO CONFERENCING

22. Small Meeting Room/ Mid-level Equipment • Dedicated digital videoconferencing equipment • Headphones • Cell phone • Room with door Pros and Cons • Moderate equipment costs • Typically can not data share beyond documents/ELMO • Higher bandwidth requirements • Control of video and audio quality • Control of far camera view

23. Desktop/Personal Equipment • Computer & Webcam • Headphones • Cell phone • Videoconferencing application • Room with door • High-speed internet connection Pros and Cons • Minimal equipment costs/readily available • Lower bandwidth requirements • No ability to control far camera view

24. Therapists’ Equipment • Desktop or laptop computer (at least 3 GB RAM for therapist) • Webcam (separate or built-in) • Headset with Mic • Printer • Scanner • Phones • Direct line to Internet (no Wi-Fi) • Teleconferencing Platform • Email

25. Therapist conducts review based on IEP goals/objectives Therapist sets and discusses goals for the current session Student engages in 1-2 activities per 30 minute session Therapist and parent review the session Therapist may assign homework as appropriate e.g. Students working on speech articulation skills can expect to produce at least 100 productions during a 30-minute session. Typical Session

26. HIPAA compliance is critical: encryption with transmission ASHA: www.asha.org/practice/reimbursement/hipaa/securityrule.htm Encryption: minimum128-bit Secure Socket Layer (SSL) Regardless of a school’s platform, sessions must be 100% private Security

27. Questions

28. Case Study: CH, Age 6-4, Kindergarten

29. Case #1: Articulation Profile: 1/15/13

30. References Dudding, C., & Justice, L. (2004). An E-supervision model: Videoconferencing as a clinical training tool. Communication Disorders Quarterly, 25(3), 145-151. Grogan-Johnson, S., Alvares, R., Rowan, L., & Creaghead, N. (2010). A pilot study comparing the effectiveness of speech language therapy provided by telemedicine with conventional on-site therapy. Journal of Telemedicine and Telecare, 16, 134-139. Grogan-Johnson, S., Gabel, R., Taylor, J., Rowan, L., Alvares, R., & Schenker, J. (2011). A pilot exploration of speech sound disorder intervention delivered by telehealth to school-age children. International Journal of Telerehabilitation, 3 (1), 31-41. Hill, A., & Theordoros, D. (2002). Research into telehealth applications in speech-language pathology. Journal of Telemedicine and Telecare, 8, 187-196. Hill, A., Theodoros, D., Russell, T., Cahill, L., Ward, E., & Clark, K. (2006). An internet-based telerehabilitation system for the assessment of motor speech disorders: A pilot study. American Journal of Speech-Language Pathology, 15, 45-56. Krumm, M. (2007). Audiology telemedicine. Journal of Telemedicine and Telecare, 13, 224-229. Krumm, M., Huffman, T., Dick, K., & Klich, R. (2008). Telemedicine for audiology screening of infants. Journal of Telemedicine and Telecare, 14, 102-104. Krumm, M., Ribera, J., & Klich, R. (2007). Providing basic hearing tests using remote computing technology. Journal of Telemedicine and Telecare, 13, 406-410.

31. References (continued) Kully, D. (2002, June 11). Venturing into telehealth: Applying interactive technologies to stuttering treatment. The ASHA Leader, 11. Lancaster, P., Krumm, M., Ribera, J., Klich, R. (2008). Remote hearing screenings via telehealth in a rural elementary school. American Journal of Audiology, 17, 114-122. Lewis, C., Packman, A., Onslow, M., Simpson, J., & Jones, M. (2008). A phase II trial of telehealth delivery of the Lidcombe program of early stuttering intervention. American Journal of Speech-Language Pathology, 17, 139-149. Palsbo, S. (2007). Equivalence of functional communication assessment in speech pathology using videoconferencing. Journal of Telemedicine and Telecare, 13, 40-43. Sciotte, C., Lehoux, P., Fortier-Blanc, J., & Leblanc, Y. (2003). Feasibility and outcome evaluation of a telemedicine application in speech-language pathology. Journal of Telemedicine and Telecare, 9, 253-258. Waite, M., Cahill, L., Theodoros, D., Busuttin, S., & Russell, T. (2006). A pilot study of online assessment of childhood speech disorders. Journal of Telemedicine and Telecare, 12, 92-94. Waite, M., Theodoros, D., Russell, T., & Cahill, L. (2010). Internet-based telehealth assessment of language suing the CELF-4. Language-Speech-Hearing Services in Schools, 41, 445-458. Wilson, J., Onslow, M., & Lincoln, M. (2004). Telehealth adaptation of the Lidcombe program of early stuttering intervention: Five case studies. American Journal of Speech-Language Pathology, 13, 81-93. 

32. Contact Information Jacquelyn Taylor 5215 Militia Hill Road, Suite A Plymouth Meeting, PA 19462 Toll Free: 910-859-9228 Email: jacquelynt@txsource.net